16 // THE NEW GASTROENTEROLOGIST: INSIGHTS FOR FELLOWS & YOUNG GIS SPRING 2016
payments for all services would be
reduced by that amount. This system
failed to account for the cost of new
technology and the fact that the individual provider had essentially no
stake in the aggregate amount of services the medical community would
provide. The result was that the
more the practitioner provided, the
more dollars would accrue to his/her
balance sheet. This led to repeated
medical “overspending,” threats to
decrease provider reimbursement
(which actually occurred in 2002),
and annual provider pilgrimages to
Congress to beg for reprieves from
any cuts to the MPFS payments with
threats of diminished access to care.
In response to the pleadings of the
medical community and the repeated
failure of the SGR to control Medicare
spending, the Medicare Access and
CHIP Reauthorization Act of 2015
(MACRA) was signed by President
Barack Obama in April 2015; ending
the use of the SGR as the mechanism
to determine provider reimbursement. MACRA put in place a 0.5%
annual increase in payment for Medicare services for a period of 5 years
beginning in 2016 and extending
through 2019, while implementing
a risk/reward system based upon
the delivery of value-based services.
This legislation is consistent with
the Centers for Medicare & Medicaid
Services’ desire to render payment
based on quality rather than volume.
It provides for a replacement of the
SGR with a system of payments/
penalties based on achieving a set
of quality measures, resource use,
clinical improvement activities, and
use of electronic health records for
patient care. The legislation also adds
to a welter of rules, reporting measures, and requirements providers
must meet to receive payment or
suffer penalties in Medicare reimbursement.
In the half-century since the cre-
ation of Medicare, we have witnessed
both the benefits and limitations of
the “Great Society” envisioned by its
authors. The intended goal of pro-
viding high-quality medical care to
seniors and the disabled at discount-
ed premium payments has required
multiple adjustments in the face of
demographic and technological real-
ities. These realities have threatened
both affordability and accessibility
for intended Medicare beneficiaries.
Whether the delivery of true quality
medicine can survive these machinations is far from certain and will
depend on a new generation of physicians to adapt to or modify the proposed changes, which involve not only
Medicare and Medicaid but private
insurance reimbursement as well. n
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of health care use by the elderly, 1965-1998.
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5. Levit K.R., et al. National health spending trends, 1960-1993. Health Affairs
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spending remained slow in 2010; Health share
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for a resource-based relative value scale. N.
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11. Hsiao W.C., et al. Assessing the implementation of physician payment reform. N. Engl. J.
The intended goal of
medical care to seniors
and the disabled at
payments has required
multiple adjustments in
the face of demographic